Functional Recovery in a Cohort of ECMO and Non-ECMO Acute Respiratory Distress Syndrome Survivors

Abstract

Abstract Background: The mortality benefit of VV-ECMO in ARDS has been extensively studied, but the impact on long-term functional outcomes of survivors is poorly defined. We aimed to assess the association between ECMO and functional outcomes in a contemporaneous cohort of survivors of ARDS. Methods: Multicenter retrospective cohort study of ARDS survivors who presented to follow-up clinic. The primary outcome was FVC% predicted. Univariate and multivariate regression models were used to evaluate the impact of ECMO on the primary outcome. Results: This study enrolled 110 survivors of ARDS, 34 of whom were managed using ECMO. The ECMO cohort was younger (32 [Q1 28, Q3 50] v. 51 [44, 61] yo, p < 0.01), less likely to have COVID-19 (58% v. 96%, p < 0.01), and more severely ill based on the Sequential Organ Failure Assessment (SOFA) score (7 [5, 9] v. 4 [3, 6], p < 0.01). ECMO patients had significantly longer lengths of hospitalization (46 [27, 62] v. 16 [12, 31] days, p < 0.01) ICU stay (29 [19, 43] v. 10 [5, 17] days, p < 0.01), and duration of mechanical ventilation (24 [14, 42] v. 10 [7, 17] days, p < 0.01). Functional outcomes were similar in ECMO and non-ECMO patients. ECMO did not predict changes in lung function when adjusting for age, SOFA, COVID-19 status, or length of hospitalization. Conclusions: There were no significant differences in the FVC% predicted, or other markers of pulmonary, neurocognitive, or psychiatric functional recovery outcomes, when comparing a contemporaneous clinic-based cohort of survivors of ARDS managed with ECMO to those without ECMO.